Provider Demographics
NPI:1093231508
Name:CUELLAR, JAQUELINE (RN)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JAQUELINE
Other - Middle Name:
Other - Last Name:OREJUELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:80 SAXON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7018
Mailing Address - Country:US
Mailing Address - Phone:631-220-2245
Mailing Address - Fax:
Practice Address - Street 1:80 SAXON AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7018
Practice Address - Country:US
Practice Address - Phone:631-220-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329440164W00000X
NY796969-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse